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May 19, 2004

Guidelines for Home- and Office-Based Blood Pressure Monitoring—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(19):2315. doi:10.1001/jama.291.19.2315-b

In Reply: We concur with Drs Kario and Pickering. Had the upper threshold of our target range of self-measured diastolic BP been less than 85 mm Hg, we might have achieved similar levels of blood pressure control in patients randomized to treatment based on self-measured BP compared with those treated based on office BP. However, this statement must be taken in the context of 3 important considerations.

First, we intentionally kept our target range of diastolic BP identical in randomized groups to allow blinded treatment decisions and direct comparison of our current results with those from our previous work.1 Second, use of lower BP targets for treatment based on self-measured BP or daytime ambulatory BP would have substantially altered the prevalence of white-coat hypertension. For instance, at baseline in our current trial (n = 400), the numbers of patients with white-coat hypertension were 107 (26.7%), 58 (14.5%), and 20 (5.0%) if the systolic/diastolic diagnostic thresholds of self-measured BP were set at 140/90 mm Hg, 135/85 mm Hg, or 130/80 mm Hg, respectively. In the 2 studies combined (n = 803), the same levels for the daytime ambulatory BP identified 158 (19.7%), 82 (10.2%), and 30 (3.7%) patients as white-coat reactors. Use of lower thresholds to fine-tune antihypertensive drug treatment based on automated techniques of BP measurement implies that fewer patients would discontinue therapy and that more would proceed to multiple drug regimens than we reported.

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